DEAR DR. ROACH: A really wholesome male buddy in his higher 50s has to decide whether or not to simply accept or decline his very aggressive urologist’s determination to do a biopsy of his prostate. Plainly the one factor prompting this determination is a current prostate-specific antigen (PSA) studying of 4 ng/mL, which has truly fluctuated a bit between 2-4 ng/mL over the previous two years. His physician states that at his age, it ought to be beneath 3 ng/mL.The doctor’s perspective is nearly dismissive of my very educated buddy’s issues about leaping right into a biopsy when he’s extraordinarily wholesome, has no signs, and has no household historical past. So, as a compromise, he prompt that he’d come again in three to 4 months for an additional studying and see how issues progress. The physician’s response basically was that my buddy can do what he needs, however the physician emphasised that that is critical and that he wants a biopsy.We each just lately learn a overview of the literature on prostate most cancers (concerning prognosis and coverings) by the Nationwide Library of Medication. It said that the suggestions for screening for prostate most cancers utilizing a PSA check are unclear! In addition they appear to say that early detection and resultant post-screening therapies can result in over-diagnosing, pointless biopsies (with typically critical unwanted effects), and the over-treatment of sufferers. — N.C.ANSWER: You’re fairly proper that the optimum technique for screening for prostate most cancers is unclear. Making the appropriate private determination requires a very good understanding of the dangers and advantages of testing, in addition to the spectrum of aggressiveness of the prostate most cancers. Bear in mind, screening at all times implies that there are not any signs current.There are a couple of males who can develop an aggressive type of prostate most cancers that grows in a short time. Sadly, it’s laborious to catch most of those cancers as a result of they develop so shortly. You need to be actually fortunate to get your screening check whereas the most cancers is large enough to be detected and hasn’t but unfold.There are a lot of males who get a really slow-growing, nearly indolent type of prostate most cancers. This type of most cancers is destined to by no means trouble most males who get it, and the bulk will die of one thing else earlier than they ever know that they had it (until they get a screening check). Therapy of this kind of prostate most cancers is pointless since it should by no means trigger issues.Lastly, there’s a group of males who’ve prostate most cancers that may be detected by screening, hopefully in time to stop the most cancers from spreading. These are the cancers we need to discover with screenings, as treating these males successfully saves lives. Nevertheless, there are far fewer of those cancers than there are of the indolent-type of cancers.The truth that his PSA degree has been secure for 2 years argues towards an aggressive most cancers, however it isn’t definitive. Males can have prostate most cancers with a PSA of two or have benign prostate illness with a PSA of 10, however normally, the upper the PSA, the better the probability of most cancers. Nevertheless, your buddy’s danger with a secure PSA degree beneath 4 is small.A very powerful time to be cautious in suspected prostate most cancers is when the prognosis has been made and the affected person is deciding on remedy. His urologist would have rather more info obtainable after a biopsy, together with pathology and genetic testing.It bothers me that the urologist is belittling your buddy’s affordable issues. This example requires respect, dialogue and understanding — not an ultimatum.Extra adviceDr. Roach regrets that he’s unable to reply particular person letters, however will incorporate them within the column at any time when doable. Readers might e mail inquiries to ToYourGoodHealth@med.cornell.edu or ship mail to 628 Virginia Dr., Orlando, FL 32803.(c) 2022 North America Syndicate Inc.All Rights Reserved